Serum and Urine Biomarker Leucine-Rich Alpha-2 Glycoprotein 1 Differentiates Pediatric Acute Complicated and Uncomplicated Appendicitis.

Mohit Kakar,Mathilde Delorme,Emile Crouzen,Lasma Asare,Aigars Petersons,Renars Broks,Juta Kroica,Astra Zviedre,Arnis Engelis,Aigars Reinis,Amulya Saxena,Marisa Maija Berezovska

doi:10.3390/diagnostics11050860

Abstract

Purpose: This prospective, single-center cohort study analyzes the potential of inflammatory protein mediator leucine-rich alpha-2 glycoprotein 1 (LRG1) for the early and accurate diagnosis of acute appendicitis (AA), and differentiation of acute complicated (AcA) from uncomplicated appendicitis (AuA). Methods: Participants were divided into the AcA, AuA, and control groups, and their serum (s-LRG1) and urine LRG1 (u-LRG1) levels were assayed preoperatively on the second and fifth postoperative days. Results: 153 patients participated, 97 had AA. Preoperative u-LRG1 with a cut-off value of 0.18 μg/mL generated an area under the receiver operated characteristic (AUC) curve of 0.70 (95% CI 0.62–0.79) for AA versus control (p < 0.001), while the results for AcA versus AuA were not significant (AUC 0.60, 95% CI 0.49–0.71, p = 0.089). The s-LRG1 levels of AA versus the control with a cut-off value of 51.69 μg/mL generated an AUC of 0.94 (95% CI 0.91–0.99, p < 0.001). The cut-off value of s-LRG1 was 84.06 μg/mL for diagnosis of AcA from AuA, and therefore, significant (AUC 0.69, 95% CI 0.59–0.80, p = 0.001). Conclusions: LRG1 exhibited excellent diagnostic performance as an inexpensive, non-invasive, rapid, and accurate biomarker able to reflect the pathogenesis of AA. LRG1 has the potential to replace advanced imaging to diagnose clinically ambiguous AA cases.

Highlights

Acute appendicitis (AA) is the most common pediatric surgical emergency, which may result in abscess, peritonitis, sepsis, ileus or death due to delayed diagnosis and treatment [1,2,3]
Samples were collected from 153 patients eligible for this research; 97 were diagnosed with appendicitis and 56 had no suspected infectious or inflammatory pathology
(77.5%) patients required the placement of a drainage tube; 83 AA patients received an abdominal ultrasound, but only 69 patients’ diagnoses were confirmed for acute appendicitis

Summary

Introduction

Acute appendicitis (AA) is the most common pediatric surgical emergency, which may result in abscess, peritonitis, sepsis, ileus or death due to delayed diagnosis and treatment [1,2,3]. Evaluation methods such as a computed tomography (CT) and diagnostic laparoscopy are applied, but these are time inefficient, costly, and invasive (e.g., CT-radiation increasing the long-term cancer risk) [9]. Current diagnostics such as leukocytosis, increased serum C-reactive protein (CRP), and abdominal ultrasound (US)

Methods

Results

Discussion

Conclusion